Many prototype practices, particularly those who had previously been involved with the pilots, have found it difficult to maintain their patient numbers and hit their capitation target.

As existing patients slip off the capitated list, it goes without saying that new patients recruited will not be a like-for-like replacement.

These new patients will require a 20-minute oral health assessment and, as the Department’s report states, 40 per cent of them will likely receive a ‘red’ risk status, with a high-treatment need.

These pressures are on top of the extra time required to implement a new clinical pathway and prevention-focused activity.

Even adopting NICE recall guidelines, patient habits take time to change and patients with high-needs, who often need the most time to treat, will need to be seen frequently.

Therefore, we’ve proposed ways for access to be redefined, that would be more appropriate for the reformed contract and that would allow practices more breathing room to meet their patient-number target and ensure patients get a real focus on prevention to safeguard their oral health.

We’ve also called for a reformed contract to use a weighted capitation, based on age, sex and deprivation as strong indicators of oral health, to support practices with the extra time and costs of treating high needs patients.

Looking ahead to the transition to a reformed contract – which still looks to be a number of years away – there is an agreement that there will be no ‘big bang’ switch-over as in 2006 and that any rollout will be gradual.

We’ve proposed doing this by age cohort over three years, with children first then adults up to 50 years old and finally older adults, who are likely to have the most complex dental needs. Even with this staged process, there will still be a great deal of uncertainty as practices adapt to a new system and, therefore, there needs to be some form of income protection for practices to ensure the level of risk is manageable.

We’ve been clear from the outset that the UDA is not fit for purpose and we’ve pushed repeatedly for a new way of measuring activity to be adopted.

In particular, we’ve called for greater remuneration for molar endodontics. Detailed work is ongoing to model how this could work and what the impact of different options might be and we’ll be advocating for the outcome that best supports dental practice’s sustainability.

With a reformed contract a while away, we’re also pushing for a number of changes to improve dentists’ working lives now, such as ensuring that UDA values are not below the band one patient charge and halting the BSA’s unjustified audits.

These proposals will form the basis of our discussions with the Department and we’ll be continuing to meet with them regularly to press for improvements to the prototypes, so that, after nearly a decade of contract reform, we can move closer to ditching the UDA system for good.

The test for the Department now is whether they will continue to kick the can down the road or finally follow their own evidence and agree to the changes we need to achieve a reformed contract that works for dentists and our patients.

Dental contract reform

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